Doctors demand return of ward rounds in hospitals

DOCTORS and nurses need to get “back to basics” by making more old-fashioned ward rounds in hospitals, says a new report.

Doctors will make more ward rounds according to a new report/posed by model []

Frontline consultants and nurses are being stretched so thin with falling staff numbers and excess paperwork that crucial ward rounds are being neglected, according to the damning report.

Crippling budgets and soaring admissions have led to a deterioration of ward rounds in hospitals, the Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) said.

This means patients are being left anxious and confused not only about their care but even in fear of suffering a serious condition that doctors are simply choosing not to discuss with them.

Experts say ward rounds must be reinstated to how they used to be because they are vital to ensure patients get the correct medication, are not dehydrated, are eating properly and to enable up-front discussions about their wishes surrounding “do not resuscitate” orders.

We do tend to miss that there is a whole person there – not just a medical condition

Suzie Hughes, chairwoman of the RCP’s Patient and Care Group

The Colleges have joined together to launch new guidelines to ensure that there is a standard of practice across all hospitals after what is described as a gradual erosion of “good ward rounds”.

And in a warning shot to NHS hospital managers, they said that daily patient contact on ward rounds are “critical” to patient care and must not be curtailed as part of time-saving or cost-cutting measures.

The quality of rounds must improve to ensure that patients are seen as people and not conditions, they said.

Dr Mark Temple, acute care fellow at the RCP’s Medical Workforce Unit, said: “Hospitals are under more pressure now than they have been in a very long time. There are huge pressures in terms of staffing, in terms of a rising tide of inpatients and emergency admissions and particularly the financial constraints on the NHS at the moment.

“There is a danger that busy clinical staff have become too task orientated and less patient orientated in relation to the tasks that they are doing.

“If you are a manager in a distant part of the hospital you may see a ward round as something that could be shortened and may not be able to measure the value of it compared to activity going through an outpatient department.

“We need to get away from a situation where a manager says: ‘Dr Temple your ward round takes three hours and you need to make it an hour and a quarter?’

“We are all under pressure to save money - we’re saying that a ward round is key to patient care and getting it right will save resources in the long term.”

Suzie Hughes, chair of the RCP’s Patient and Care Group, said: “We can’t underestimate just how important the ward round is to patients, and it should be very important to staff as well.

“The holistic approach to ward rounds is something that is incredibly important and we do tend to miss that there is a whole person there - not just a medical condition.

“There has been a gradual erosion of what I would call a good ward round but there are some areas out there of extremely good practice that we can all learn from.”

One of the recommendations set out by the Colleges is to ensure that a nurse participates in each ward round.

Dr Temple added: “Nurses are in a unique and privileged position because they are present on the ward around the clock caring for the patients and they bring to the ward round vital information that may be gleaned in the care of that patient, information from relatives or carers who are visiting and also professional insights.”

The Colleges also said that patients should be given a clear summary after each ward round, the multidisciplinary teams should use check lists to ensure that they have not missed anything and that patients records should be kept centrally to avoid errors.

Patients with dementia or learning disabilities should have the support where possible to make decisions about their future care and all ward rounds should be conducted in the mornings, they said.

Steve Jamieson, RCN head of development, said: “Patients can be left until 4pm or 5pm before they are even seen so they spend the day worrying about what’s going to be said, what the treatment programme is going to be, if they are going to be discharged that day, so it’s about making sure that team can make that ward round as soon as they possibly can in the morning.”

NHS Confederation chief executive Mike Farrar said: “If we are to improve standards of care then it is essential we empower ward staff to plan care, take responsibility for staffing levels and design systems that are in the best interests of patients.”

Katherine Murphy, chief executive of The Patients Association said: “This a very welcome report for patients. Ward rounds are a positive way of co-ordinating care and enabling healthcare professionals to engage with patients. Our helpline hears from patients and relatives every day who feel let down by poor communication, such as a lack of information about their treatment plan.

“High quality, consistent ward rounds in every hospital would contribute to a more patient centred culture in the NHS. This is crucial reading for the Government and Trusts.”